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Vol. VIII, No. 13 ~ EINet News Briefs ~ Jun 24, 2005


*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- Viet Nam: More rapid confirmation of reported new human cases of avian influenza necessary
- Viet Nam: 2 more avian influenza patients reported
- Thailand/Hong Kong: Avian influenza - autopsy report
- Indonesia: Farm Worker is First Confirmed Human Case of Avian Influenza
- China: The Ministry of Agriculture says misuse of antiviral on poultry must stop
- China: New outbreak of bird flu registered
- Indonesia: 5 more polio cases confirmed, 51 cases total
- Taiwan: 10 new cases of Hand, foot & mouth disease
- Russia: Hepatitis A sickness rate in Tver Region reaches 662; Hep. A statistics in Moscow
- Thailand: Leptospirosis Outbreak in Kalasin
- Australia: Cryptosporidiosis widespread in New South Wales
- New Zealand: Epidemic of influenza B virus infection
- USA: Tests confirm second mad cow case
- USA (New York): South Korea and Japan Ban Poultry Import From New York
- USA: 2 Hantavirus patients from Colorado treated in New Mexico; HPS statistics update
- USA (Illinois): Area salmonella outbreak climbs to 22 cases, several hospitalized
- USA (Multi-state): Salmonella outbreak linked to state hatchery
- USA (Massachusetts): Outbreaks of adenovirus infection in mental health facilities
- USA (Massachusetts): About 1600 Patients, Health Care Workers Exposed To TB

1. Updates
- Influenza
- Cholera, diarrhea & dysentery
- Dengue/DHF

2. Articles
- CDC EID Journal, Volume 11, Number 7-July 2005
- Foreign Affairs focuses on pandemic threat
- Seroprevalence of poliovirus antibodies among children in a Dominican community--Puerto Rico, 2002
- HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex with Men--Five U.S. Cities, June 2004--April 2005
- Use of Social Networks to Identify Persons with Undiagnosed HIV Infection--Seven U.S. Cities, October 2003--September 2004

3. Notifications
- CDC Update: Notice to Travelers, Avian Influenza A (H5N1)
- Fourth annual Syndromic Surveillance Conference
- APEC Workshop on Development and Adoption of International Setting with a focus on Plant and Animal Health
- APEC Symposium on Response to Outbreaks of Avian Influenza and Preparedness for a Human Health Emergency
- FDA approves a new vaccine to help protect adults against pertussis
- National HIV Testing Day--June 27, 2005
- Management for International Public Health Course

4. APEC EINet activities
- EINet article on Seattle Times' Editorials/Opinion section

5. To Receive EINet Newsbriefs
- APEC EINet email list


Asia
South East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
Cumulative number of confirmed human cases of avian influenza A/(H5N1), 16 Dec 2004 to present:

Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
Indonesia / 1 (0) / 0 (0)
Cambodia / 4 (4) / 4 (4)
Thailand / 0 (0) / 0 (0)
Viet Nam / 68 (63) / 22 (22)
Total / 56 (56) / 22 (22)

Cumulative number of confirmed human cases of avian influenza A/(H5N1), 3 Dec 2003 to present:
112 (107) / 54 (54)
(CIDRAP 6/21/05 http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html)

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Viet Nam: More rapid confirmation of reported new human cases of avian influenza necessary
Dr. Klaus Stohr warned that unless the WHO receives information on a more rapid basis, hopes of trying to extinguish an emerging pandemic at source will be jeopardized. Biostatisticians have been developing mathematical models to try to assess whether it would be feasible to stop an emerging pandemic in Southeast Asia, using a combination of the antiviral drug oseltamivir and strict quarantine. One of the models was produced by Ira Longini, a professor of biostatistics at Emory University. Longini said the work suggests there might be a chance of averting disaster if all the right conditions are met. Those conditions include a sputtering start in a rural setting, with a virus that doesn't transmit well in the first few generations of cases. "In a rural area, you could intervene within say 3 weeks of the first symptomatic case. At that point, containment is still possible," Longini said. But both he and Stohr stressed the plan could only work if the world moves quickly. "If the objective is to attempt at eliminating the virus at its source, as the models say is possible, then we have to consider the conditions under which that would be feasible," he noted. "And the conditions would be that one would not only have to reach a relatively large proportion of people in a given area but also to move fast." (Promed 6/16/05)

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Viet Nam: 2 more avian influenza patients reported
2 more Vietnamese residents have contracted avian influenza in the country's north. The 2 avian influenza patients were among 5 people admitted to a hospital in Hanoi with sore throat or bronchitis, the Saigon Giai Phong said. The latest cases took the number of Viet Nam's avian influenza patients since Dec 2004 to 64, 18 of whom have died. The Health Ministry insisted that there has so far been no evidence of human-to-human transmission of the virus. Meanwhile, more than 4000 out of 6700 chickens on a farm in the southern province of Ben Tre died 9 Jun 2005, said Mai Van Hiep, director of the provincial animal health bureau. The authorities killed the remaining chickens, and tests showed they were infected with the H5N1. Hiep said it was the first reported outbreak in the province since Mar 2005. Ben Tre is one of the areas where the virus first emerged in 2003 then spread to the north, where the virus appears to develop rapidly during winter. The first wave of the virus saw it spread to 57 of Vietnam's 64 provinces and cities. During the 2nd wave from the end of 2004 and Apr 2005, the virus as affected bird populations in 36 provinces and cities, and 1.6 million birds have died or been culled. A second test of the doctor from Bach Mai Hospital was reported as negative and the diagnosis of influenza infection remains to be confirmed. (Promed 6/21/05, 6/18/05)

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Thailand/Hong Kong: Avian influenza - autopsy report
Researchers from Thailand and Hong Kong will report the findings of an autopsy of a 6 year old Thai boy who died from avian influenza in the July 2005 issue of Emerging Infectious Diseases http://www.cdc.gov/ncidod/EID/index.htm. Their findings of an atypical pattern of infection--deep in the lungs, away from the tracheal lining where virus could easily be coughed out at others--may help explain why H5N1 influenza virus doesn't yet spread easily among people. But the very fact that a paper containing autopsy data from a single case is still desirable to journal editors a year-a-half into the avian influenza outbreak underscores a problem that has been plaguing the scientific world's pursuit of knowledge about this strain of influenza virus. While at least 54 people have died from H5N1 infections since Dec 2003, autopsies have been performed on a just a few cases. Most have been buried or cremated.

"If we want to test vaccine or antiviral strategies for intervention, we would like to know what the disease looks like in humans," explains Ab Osterhaus, head of virology at the Eramus Medical Center in the Netherlands. Determining which organs the virus is attacking is also crucial for infection control, because it helps identify possible modes of transmission. If H5N1 replicates in the human gastrointestinal tract, patients who experience diarrhea could contaminate their environments in ways health care workers might not expect from a respiratory virus. The autopsy on the Thai boy found viral replication in the intestine. Autopsies could also show whether the virus is being spread through the blood supply to other organs, says Dr Jagdish Butany, who performed the first autopsy done on a SARS patient in Canada. He acknowledges that, in certain cultures and religions, getting permission from relatives to conduct autopsies is virtually impossible. Even if more people were willing to authorize postmortems, Earl Brown, a virologist at the University of Ottawa, says H5N1 influenza isn't claiming its victims fast enough. "They die after several weeks in intensive care, and all the (viral) tracks are gone...” (Promed 6/21/05)

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Indonesia: Farm Worker is First Confirmed Human Case of Avian Influenza
A farm worker in eastern Indonesia has tested positive for avian influenza virus, marking him the country's first human case of the virus infection, officials in Indonesia said 15 Jun 2005. The worker from southern Sulawesi island is healthy and currently shows no symptoms of illness but two tests at a Hong Kong lab confirmed that he had been infected by avian influenza virus. The laboratory results make Indonesia the fourth country to register a human case of avian influenza. Since 2003, the disease has struck poultry in 18 Indonesian provinces, prompting the government to order a campaign to vaccinate poultry. Indonesian health experts, however, have been saying the local virus was slightly different from the strain in other Asian countries and had demonstrated no capability to infect people. The farm worker was initially tested in March after the epidemic spread to Sulawesi, killing at least 25 000 chickens. That outbreak prompted officials to take blood samples from laborers, veterinarians and others exposed to sick chickens. In total, 81 people were tested and all but one of the samples came back negative. The second test confirmed that the laborer had been infected by bird flu but the concentration of antibodies was relatively low. That finding meant the worker was no longer carrying the virus but it was impossible to determine how long ago he had been infected.

Even if a person shows no symptoms, the infection still poses a serious health risk. Health experts worry that a person could catch both avian influenza and an ordinary human strain of influenza virus at the same time, presenting a chance for the viruses to swap genes and produce a new strain that can be passed among people. Avian influenza virus has also infected Indonesian pigs; a similar genetic change could occur in swine, which can catch both avian and mammalian influenza viruses. (Promed 6/15/05)

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China: The Ministry of Agriculture says misuse of antiviral on poultry must stop
The Ministry of Agriculture (MOA) plans to dispatch inspection teams nationwide to stop the antiviral drug amantadine, which is meant for humans, from being used on poultry. An MOA official said that some farmers are illegally using amantadine on their chickens to curb the spread of bird flu. Researchers fear using the drug on animals and humans could lead to drug resistance. Drug-resistant forms of H5N1 have already been found in Thailand and Viet Nam, according to reports. The government has never permitted farmers to use amantadine to treat bird flu, said Xu Shixin, MOA's division director of the veterinary bureau. Xu refuted a report that the Chinese Government had encouraged farmers to use amantadine on their chickens to prevent bird flu. Xu said the government would supply farmers with cheaper and more effective vaccines to replace the use of amantadine by some farmers. WHO and the UN Food and Agriculture Organization have both expressed concerns. Previously, several avian influenza virus strains of hemagglutinin subtype 5 were found to exhibit resistance against amantidine. Mutation to amantadine-resistance occurs at appreciable frequency and this has limited the use of amantadine in human medicine. Another limitation for humans is that it must be administered 24 hours before exposure to infection and it must be maintained at high concentration for at least 10 days. Side effects are common. (Promed 6/21/05)

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China: New outbreak of bird flu registered
China reported a new outbreak of bird flu which has infected 128 geese and ducks in Xinjiang region, killing 63 of them, the UN Food and Agriculture Organization said. The outbreak--the third reported by the Chinese government in the past 2 months--occurred in Changji city near Urumqi, the capital of Xinjiang, the FAO said. Authorities have culled 1490 birds, including the infected geese and ducks and those raised in nearby farms. No human cases were reported. The infected birds were determined to have died from H5N1 strain of bird flu. Earlier in June 2005, 1042 geese were infected with H5N1 at a farm in Tacheng city in northwestern Xinjiang, near the border with Kazakhstan, with 460 of them dying.

Also, the 519 wild bird deaths at the Qinghai Lake Nature Reserve in Gangcha County, Qinghai Province were confirmed by the National AI Reference Laboratory to be due to H5N1. More than 3 million doses of vaccine against the H5N1 strain were dispatched to Qinghai. Qinghai adopted a series of measures, such as sealing off the epidemic area, the use of disinfectants in the affected zones as well as the administration of vaccines. Death of migratory birds was first reported in Gangcha County 4 May 2005. (Promed 6/20/05, 6/22/05)

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Indonesia: 5 more polio cases confirmed, 51 cases total
On 20 June 2005, 5 new polio cases were confirmed in Indonesia, bringing the total number of cases to 51. Two of these cases are from Bogor district, one from Cinajur and one from Sukabumi, all in the province of Jawa Berat. The most recent of these new cases had onset of paralysis 28 May 2005, before the immunization 'mop-up' campaign held 31 May to 2 June 2005. The fifth case is from Demak district in Jawa Tengah, a hitherto unaffected province and outside the area where the 'mop-up' campaign was held. WHO said nearly 500 new polio cases have been confirmed worldwide in 2005. Polio is spread when unvaccinated people come into contact with the feces of those with the virus, often through water. It usually attacks the nervous system, causing paralysis, muscular atrophy, deformation and sometimes death, though only about one in 200 infected ever develop symptoms. (WHO 6/20/05 Promed 6/20/05)

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Taiwan: 10 new cases of Hand, foot & mouth disease
From 4 Jun to 10 Jun 2005, 10 new severe enterovirus infections were confirmed in Taiwan, bringing the total number of cases to 60. Of these cases, 5 deaths in children have been reported. The case number and death toll of the disease from 1 Jan to 10 Jun 2005 are much higher than those within the same period from 2004 (14 cases with no deaths). So far, all these cases are less than age 5. This year's enterovirus epidemic occurred predominantly in the Central Taiwan with 34 cases, followed by Northern Taiwan (14), Southern Taiwan (11), and Eastern Taiwan (1). The epidemic curve of reported severe enterovirus infections in Central Taiwan and Northern Taiwan has been gradually descending; however, it seems to be slightly rising in Southern Taiwan. Of the 60 confirmed cases in 2005, at least 30 cases were associated with enterovirus 71 (EV71) infections, which were lab-confirmed. Subtype C of EV71 is responsible for hand, foot & mouth disease this season and those of 2004 and 1978. The 1999-2003 outbreaks were attributed to Subtype B. Both subtype B and C will cause severe cases. (Promed 6/11/05)

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Russia: Hepatitis A sickness rate in Tver Region reaches 662; Hep. A statistics in Moscow
The number of people who have fallen ill with hepatitis A in south western districts of the Tver region has reached 662, including 182 children, the crisis headquarters set up to combat the epidemic said 22 Jun 2005. So far 241 people have been discharged from hospitals. The hepatitis outbreak is coming to an end in the region, but more cases might be reported, medics said. The gradual decline of the outbreak is consistent with the identification of the source of the outbreak as a breach of hygiene at a large supplier of both alcoholic and non-alcoholic drinks to the region.

The hepatitis sickness rate in Moscow increased 1.5 times in the first 5 months of 2005 compared with the same period in 2004. The city's State Sanitary and Epidemiological Service said hepatitis in the designated period had sickened 1130 people, including 164 children. The hepatitis sickness rate among children had increased 31.4 per cent. "Whereas some 270 hepatitis cases were registered each month in the period from January through March [2005], the number of contacts decreased to 180 in April and to 136 in May 2005," the service said. 176 people fell ill with hepatitis A in Moscow from 20 Apr to 14 Jun 2005. As many as 157 adults and 15 children were hospitalized. However, 96 per cent of cases appear sporadic. Vaccination against hepatitis A among high-risk groups in Moscow is underway. A total of 1500 people have already been inoculated, epidemiologists said. (Promed 6/22/05)

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Thailand: Leptospirosis Outbreak in Kalasin
An outbreak of leptospirosis has been reported in Thailand's Kalasin province.10 patients have been found suffering from the disease so far, according to the Director of Kamalasai Hospital, Dr. Supat Thartpetch. "The disease normally spreads during rice harvests in the rainy season through mud tracks in rice fields. So, people with any leg wounds, even minor ones, should refrain from walking through the rice fields, or wear long boots to prevent themselves from the disease", he said. People who have contracted the disease will suffer from a high fever with red eyes, red urine, and wearied leg muscles. (Promed 6/14/05)

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Australia: Cryptosporidiosis widespread in New South Wales
New South Wales Health is urging anyone who has recently suffered from diarrhea not to swim in public pools following a cryptosporidiosis outbreak. NSW Health communicable diseases director Dr Jeremy McAnulty said the disease was spread by direct contact with people who had diarrhea or by swallowing contaminated water, usually from swimming pools. About 180 cases of the intestinal infection were reported during Apr and May 2005, with almost half the cases being children aged under 5. Dr McAnulty said anyone with the illness should not swim until one week after recovery. No specific treatment was available for the infection, from which it usually took 4 weeks to recover, he said. Transmission of Cryptosporidia through swimming pools is well known, and the cysts of the parasite are resistant to chlorine, which makes disinfection of the pool difficult. (Promed 6/17/05)

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New Zealand: Epidemic of influenza B virus infection
New Zealand is currently experiencing an epidemic of influenza B virus infection. Both influenza B Shanghai-like virus and influenza B Hong Kong-like virus have been isolated. Influenza B Hong Kong-like virus is currently the predominant strain. Children and young people are predominantly affected with absenteeism rates in some schools greater than 20 per cent. Currently, 3 deaths have been identified in association with this epidemic: 1) A child who developed Reye syndrome. This child was on aspirin for another condition; 2) An otherwise fit and well adolescent who developed Staphylococcus aureus pneumonia and septicemia. 3) An otherwise fit and well child who developed Staphylococcus aureus pneumonia and septicemia. The viral isolates in all 3 cases have been identified as an influenza B Hong Kong-like strain. (The current Southern Hemisphere vaccine contains an influenza B Shanghai-like strain). Further information on influenza in New Zealand can be found at http://www.surv.esr.cri.nz/virology/influenza_weekly_update.php.

The Ministry advised parents and clinicians to be vigilant. Dr Tuohy, chief advisor child and youth health, said, "In New Zealand, we have not seen large numbers of people infected with this type of influenza (Hong Kong B) since 1987, although a few people had it in 2002. What that means is that most people born since 1987 will not have natural immunity and are hence more likely to be susceptible," he said. "All parents, caregivers and clinicians need to be aware that the impact of influenza B on children and adolescents can be much more severe than has previously been recognized…" Dr Tuohy said. He said the annual influenza immunization is the best form of defense against influenza, and he urged people to get immunized, particularly those who are most vulnerable and in the at-risk groups. (Promed 6/22/05)

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Americas
USA: Tests confirm second mad cow case
Tests have confirmed mad cow disease (bovine spongiform encephalopathy; BSE) in a US cow previously cleared of having the illness, the US Agriculture Department said. It is the second case of BSE in the US. An internationally recognized laboratory in England confirmed the BSE case after US tests produced conflicting results, Agriculture Secretary Mike Johanns said. Human health was not at risk, Johanns said. The animal was a "downer", unable to walk. Such animals are banned from the food supply. The department has said there was no reason to believe the animal was imported. The first case confirmed in the US was in Dec 2003, a dairy cow imported from Canada. "I am encouraged that our interlocking safeguards are working exactly as intended," Johanns said at a news conference. "This animal was blocked from entering the food supply because of the firewalls we have in place…" he said. The department did initial screening using a "rapid test", which was positive. A more detailed immunohistochemistry test was negative. But the department did not conduct a third round, using Western blot test, until ordered by the department's inspector general. Now the department will use both IHC and Western blot when rapid tests indicate the presence of the disease, Johanns said.

The animal involved was born before Aug 1997, when the government imposed new feed rules designed to prevent the spread of the illness, the USDA said. That means that if tests confirm that the animal was infected, it may have contracted the disease prior to the 1997 ban, and that the feed restrictions have been working as designed, said Dan Vaught, a livestock analyst with A.G. Edwards & Sons Inc. (Although the feed ban rule was put into place by the FDA, it is the USDA that is charged with animal disease and health. So when the feed ban is violated on a farm, FDA does not appear to have an enforcement arm; but as the disease has a long incubation, it is outside of the jurisdiction of the USDA. It will not be surprising if the US has a BSE-affected animal that is born after the ban.)

Beef shipments to Japan were cut off Dec 2003 following the U.S. announcement of its first BSE case. Before its ban, Japan was the No. 1 beef market for the US, buying $1.4 billion annually. South Korea was its third-largest market. The Japanese government agreed in principle to resume beef imports from American cattle aged 20 months or younger, but insisted shipments would not resume until its independent commission declared U.S. beef safe. Current negotiations with South Korea center on beef from animals under 30 months. Scientists believe BSE takes several years to incubate within an animal's nervous system, making young cattle far less risky. After the discovery in 2003, 53 countries banned American cattle. Since then, about one-third of exports have resumed. Beef has soared to record prices in American grocery stores, and meatpackers have struggled from the lack of Canadian cattle they normally count on (The U.S. border has also been closed to imports of Canadian cattle since May 2003, when Canada found its first BSE case). The $7.5 billion American beef and cattle industry has lost more than $4 billion a year since the first US case was discovered. (Promed 6/11/05, 6/14/05, 6/24/05)

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USA (New York): South Korea and Japan Ban Poultry Import From New York
South Korea has halted the import of poultry products from New York State, after the US reported a suspicious case of bird flu in the region, the Ministry of Agriculture and Forestry said 14 Jun 2005. Japan also ordered a ban on the importation of chicken from New York. The U.S. Agriculture Department informed the World Organization for Animal Health 10 Jun 2005 of the outbreak of a low-pathogenic bird flu (H7N2) case on a duck farm in Sullivan, New York. The virus is known as the H7N2 strain, but it can develop into a high-pathogenic one and infect humans, the ministry said, adding the U.S. farm authorities are conducting further tests. The country's quarantine halt is limited only to poultry from New York, and it will be lifted once the influenza is confirmed to be low-pathogenic. South Korea banned imports of U.S. poultry in Feb 2004, citing dangers of avian influenza infection, but reopened the market May 2005. (Promed 6/15/05)

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USA: 2 Hantavirus patients from Colorado treated in New Mexico; HPS statistics update
The University of New Mexico Hospital is treating 2 more hantavirus patients, bringing the total to 6 in 2005. A 61-year-old woman was admitted 5 Jun 2005, and a 62-year-old woman was admitted 8 Jun 2005. Both women are from southern Colorado and in critical condition. New Mexico hasn't reported a hantavirus case in 2005, but experts have warned that the wet weather of winter and early spring could mean higher populations of mice this year. New Mexico has recorded a total of 63 cases of hantavirus. 27 of those cases have been fatal. Hantavirus is passed to humans when they inhale particles of dried urine or feces from infected rodents, especially deer mice. The problem most often occurs when people enter buildings that have been closed for a while and have been infested by mice. The illness is marked by fever, headache and muscle ache, possibly with chills, nausea and vomiting, and progresses rapidly to severe difficulty in breathing and, in some cases, death. Symptoms develop one to 6 weeks after exposure.

Through 3 May 2005, a total of 387 cases of hantavirus pulmonary syndrome (HPS) have been reported in the US (rising to 389 with the inclusion of the 2 Colorado cases). 36 percent of all reported cases have resulted in death. Of persons ill with HPS, 62 percent have been male, 38 percent female. The mean age of confirmed case patients is 38 years (range: 10 to 83 years). Whites account for 78 percent of all cases, American Indians for 19 percent, African Americans for 2 percent, and Asians for 1 percent. About 13 percent of HPS cases have been reported among Hispanics (ethnicity considered separately from race). The distribution reflects a spring-summer seasonality, although cases occur throughout the year. Cases have been reported in 30 states, including most of the western half of the country and some eastern states. Over half of the confirmed cases have been reported from areas outside the Four Corners area. About 75% of patients with HPS have been residents of rural areas. (Promed 6/19/05)

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USA (Illinois): Area salmonella outbreak climbs to 22 cases, several hospitalized
The Madison County Health Department reported 13 Jun 2005, that 22 confirmed cases of salmonella have been linked to Casa Romero Restaurant in East Alton. The 22 people visited the restaurant 21 May - 3 Jun 2005, said Public Health Administrator Tina Corona. She said several of those infected are employees of the restaurant. "It looks like the original transmission was from an infected person, but to find out exactly where it came from is nearly impossible," she said. Several people infected were hospitalized. The restaurant will remain closed until a lab report is concluded, basic food safety is explained to employees, and all employees have tested negative for salmonella. (Promed 6/14/05)

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USA (Multi-state): Salmonella outbreak linked to state hatchery
17 cases of salmonella infection in the Southwest US since Apr 2005 have been linked to a single New Mexico hatchery. New Mexico Department of Health Public Information Officer Deborah Davis said salmonella is a naturally occurring bacteria in poultry and could be found in any bird at any poultry farm. State Public Health Veterinarian Paul Ettestad said a few children with the illness had been hospitalized, but have since returned home. No deaths have been reported. Ettestad said the department's investigation traced the outbreak to baby chicks purchased from feed stores from Jan 2005 to Easter. "Most cases were found in children one year of age and younger that contracted salmonella," he said. "We found that parents were allowing these baby chicks in the confines of their home and around their children." Initially, there were 9 cases being investigated, according to a press release from the New Mexico Department of Health. 25 cases of have been reported in 14 states thus far. (Promed 6/15/05)

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USA (Massachusetts): Outbreaks of adenovirus infection in mental health facilities
17 people were admitted to hospital after an outbreak of a viral illness in 8 mental health facilities in Brockton and nearby towns, state Department of Public Health said 21 Jun 2005. A total of 28 clients and staff in 8 state Department of Mental Health facilities contracted adenovirus infection. An unknown number of clients from New Beginnings Club House in Brockton, which is run by the state Department of Mental Health, were among those who became ill. 17 people were taken to Brockton Hospital and 15 who became ill developed pneumonia. The virus requires very close contact for transmission. Clients and staff of the state Department of Mental Health became ill 23 May - 17 Jun 2005. All of the facilities have implemented careful respiratory precautions, including not sharing food and other precautions. Symptoms of adenovirus include coughing, fever, aches and diarrhea, said Dr Brian Dolan, director of the hospitalist program at Brockton Hospital. The virus is spread through coughing or hand-to-mouth transmission. It can manifest itself as gastroenteritis or as an upper respiratory infection. Adenovirus infection tends to run its course within one to 2 weeks and may take longer. Treatment include administering intravenous fluids, breathing treatments and anti-viral medications. Adenovirus is known to cause outbreaks in closed populations such as military barracks, nursing homes or facilities for the mentally handicapped, he said. Live and inactivated vaccines have been developed but not employed widely except by the military. (Promed 6/23/05)

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USA (Massachusetts): About 1600 Patients, Health Care Workers Exposed To TB
Dr. John Rich of The Boston Public Health Commission said that they have diagnosed a case of active tuberculosis (TB) in a surgical intern. She is now on leave and undergoing treatment; she worked at 4 Massachusetts hospitals: West Roxbury Veterans Affairs Hospital, Cape Cod Hospital, Boston Medical Center, and Brockton Hospital. "We would estimate that approximately 1600 people might have had contact with the infected health care worker. That is a large number and most of those individuals will not have any infection related to this at all," he said. Experts said there is no threat to the general public. "We are working together to ensure that every person for whom there was any risk of exposure or infection is contacted and has the appropriate testing and referral that is necessary to reassure them," said Rich.

TB is caused by bacteria that are released into the air by an infected person. AntiTB agents usually are effective in treating the disease. TB has re-emerged as a serious health problem. The biggest problem is the active form that can be passed from person to person, although quite a bit of exposure to an infected person is needed. On average, people have a 50 percent chance of becoming infected if they spend 8 hours a day for 6 months with an infected person. Not everyone who gets infected will know it--the bacteria can lie dormant for years, without causing symptoms. Most clinicians have seen transmission with a much more minimal exposure, however. Overall, the risk of acquisition of TB is generally defined not as the number of secondary cases of active TB--since activity may not be seen until years later--but rather the number of contacts who become tuberculin skin test convertors. The risk of skin test conversion is related to whether the index case has positive sputum acid-fast bacillus smears, the amount of cough, and the degree of direct contact. Of those contacts who become tuberculin skin test reactive, about 10 percent of the total will eventually develop active TB. Half of these will have active disease in the first 2 years and the other half, sometime during the rest of their lives. If the contacts are profoundly immunocompromised, the risk of active TB is closer to 10 percent per year. (Promed 6/16/05)

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1. Updates
Influenza
Seasonal influenza activity for the Asia Pacific and APEC Economies
In week 22, a slight increase in influenza activity was observed in some countries in the southern hemisphere. In the northern hemisphere, influenza activity was low, with the exception of Hong Kong.

Canada. Localized influenza activity was reported from 2 provinces; in rest of Canada activity was low.

Chile. A local outbreak of influenza A was reported in southern Chile in week 22. This is the first influenza outbreak reported in Chile so far this season. Influenza B viruses were also detected.

Hong Kong. Influenza activity remained high in the previous 12 weeks, with large numbers of influenza viruses isolated each week, the majority of which were influenza A(H3N2). In week 22, a total of 653 influenza viruses were isolated.

New Zealand. Increasing levels of influenza-like illness continued to be recorded and a number of outbreaks in schools caused by influenza B were reported in week 22.

Other reports. In week 22, low influenza activity was detected in Australia (A, B) and Mexico (H3). (WHO 6/15/05 http://www.who.int/csr/disease/influenza/update/en/)

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Cholera, diarrhea & dysentery
USA (Hawaii)
2 cases of cholera believed related to eating seafood were reported to the state Health Department in Apr and May 2005. The disease is rare in Hawaii, with only 1 case reported in 2004. With 2 occurring in 2 months, physicians were alerted, Dr. Sarah Park, deputy chief of the Disease Control and Outbreak Division, said 14 Jun 2005. She said the cases involved an older woman and a young male. The woman was seen in an emergency room, given antibiotics and fluids and was fine; the young man also recovered after seeing a physician and taking some medications. The cases had eaten at different seafood restaurants in a chain, Park said. Health inspectors weren't able to identify a common source of the disease. Cholera is caused by Vibrio cholerae. It is contracted through contaminated water or food, particularly shellfish. Characteristic symptoms include diarrhea, vomiting and leg cramps. She said the best way to prevent cholera is to make sure food is well-cooked. The freezing process doesn't kill Vibrio cholerae. (Promed 6/15/05)

USA (Kentucky)
Some Lexington day care centers are still experiencing new cases of shigellosis, a form of dysentery that causes diarrhea, vomiting, and fever, the Lexington-Fayette County Health Department reported 21 Jun 2005. As of 20 Jun 2005, 55 cases had been confirmed in the county. As of 2 Jun 2005, there were 22 cases. The 33 new cases have occurred mostly among children ages 4 years and under. 49 of the cases have been associated with 10 day care facilities in Fayette County. Antibiotics can treat shigellosis, and patients usually recover in 5 to 7 days. CDC advises against using antidiarrheal agents to treat symptoms. (Promed 6/10/05, 6/24/05)

Malaysia (Sabah)
State Health Department deputy director Dr. Mohd Yusof Ibrahim said the closure of 41 eateries followed an inspection of all the eateries in the district by a team of health officers. The inspection was conducted in light of the cholera outbreak since May 2005. In May 2005, 116 students were warded at the Semporna District Hospital, after being confirmed as cholera carriers. More than 160 people sought treatment at the hospital for cholera symptoms over the second week of June 2005, with 17 confirmed cases. (Promed 6/19/05)

Philippines
At least 9 people, mostly children, died, while 70 others got ill, in what officials said was an outbreak of diarrhea in at least 3 remote villages of Palimbang town in Sultan Kudarat. Palimbang Mayor Labualas Mamansual said that 7 of those who had died since the outbreak started around the beginning of June 2005 were from Barangay Domulol. The 2 other affected villages were Kra'an and Malisbong. The victims died of apparent dehydration. Of the 70 people afflicted, at least 30 come from Domulol. (Promed 6/19/05)

Taiwan
The CDC confirmed 23 Jun 2005 the first indigenous case of cholera in Taiwan since 2000, noting that it had reported to the WHO. The lab test results on the patient showed positive for cholera toxin, said Chou Chih-hao, deputy director of the CDC. The patient was a 72 year old woman resident of Tainan County. The case was reported to the CDC by Tainan's Chi-Mei Hospital 20 Jun 2005. The woman fell ill 15 Jun 2005. Before falling ill, she sampled an assortment of steamed eggs displayed in a market, investigators from the county's health department discovered. They have procured some of the eggs for testing. Heath officials have speculated that the patient, in sampling the steamed eggs, could have touched the food after she touched raw seafood. Because of comprehensive upgrades of Taiwan's improved sanitation, the nation has managed to keep the disease at bay for the past 5 years--discounting a few imported cases in which people had fallen ill after returning from trips to Indonesia, the Philippines and Thailand. (Promed 6/24/05)

Hong Kong/Indonesia
The Centre for Health Protection has confirmed the year's first cholera case. A woman aged 27 developed diarrhea, nausea and vomiting 17 Jun 2005 and was admitted to Princess Margaret Hospital 22 Jun 2005. She is in a stable condition. She had lived in Indonesia and arrived in Hong Kong 15 June 2005. (Promed 6/24/05)

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Dengue/DHF
Philippines
Dept of Health records showed that from Jan - May 2005, at least 1000 persons had been afflicted with dengue, and 32 had died. Authorities in South Cotabato were set to conduct a comprehensive study on the resurgence of dengue fever and malaria cases. Dr Conrado Bra, chief of the provincial hospital here, said that the peak of dengue cases in the province is usually during August, but they already recorded 80 cases in Jan 2005. For malaria, he said the disease peaked in Jul 2004 with 59 cases, but by May 2005 alone, 82 cases were already recorded. Data obtained from the Integrated Provincial Health Office's (IPHO) shows that at least 301 cases of dengue were reported since Jan until May 2005, just 3 cases short of last year's total of 304 cases. For malaria, the IPHO recorded at least 188 cases as of May 2005. Last year's total number of malaria cases reached 274.

Dengue is an acute viral disease transmitted through the day-biting mosquito Aedes aegypti. Malaria, on the other hand, is caused by a parasite. Humans get it from the bite of a malaria-infected mosquito. Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. The death rate in Philippines was still low, with only 2 deaths from malaria and one from dengue. The IPHO earlier blamed the rising number of dengue and malaria cases to this year's "unusual weather conditions"—i.e. the recent drought or El Nino phenomenon, which intensified Feb-Apr 2005, and the sudden shift to the rainy season in May 2005. (Promed 6/12/05, 6/23/05)

Viet Nam
Viet Nam's southern Mekong Delta has had over 6700 cases of dengue fever, including 3 fatalities, for the first 5 months in 2005, the local health authority reported. The provinces of Soc Trang and Dong Thap reported the highest number of cases, at about 1000 each. Meanwhile, the number of dengue fever patients is increasing in An Giang and Ben Tre. Doctors from the Preventive Health Care Center also predicted outbreaks of dengue fever in local provinces, as the rainy season has begun. (Promed 6/12/05)

Thailand
In southern Thailand, more than 16 percent of the population is reportedly suffering from dengue fever, according to the director of the local disease prevention office, Dr. Boonchai Poomborplab. The highest incidence of the disease is in Songkhla, where there are 181 dengue fever cases, followed by Trang with 164 cases, and Pattalung with 103 cases. However, there have been no reported deaths from the disease in any of the southern provinces so far, after a 13-year-old boy in Bangkok died of dengue shock syndrome May 2005. The 3 southernmost provinces will be kept under strict surveillance despite the low rates of dengue cases. According to the official surveillance, there have been more than 8000 reported dengue fever cases in Thailand in 2005. 16 people have died. The number of patients and deaths is expected to increase, especially during rainy season in June-August 2005. During 2004, 38 000 people contracted the disease, and 40 died, most in the 10-14 year age group. (Promed 6/12/05)

Hong Kong/Indonesia
The Centre for Health Protection has confirmed an imported case of dengue fever involving a 67 year old man, bringing the total number of cases to 8, all imported so far in 2005. The patient developed fever, tiredness, dizziness, headache, and pain in his eyes 15 Jun 2005 after having visited Indonesia from May 15 to June 11 2005. He was admitted to Princess Margaret Hospital Jun 18 in a stable condition. His contacts have no symptoms of infection. The latest information on dengue fever in other places can be found under "Outbreak News" on the Department of Health's Hong Kong Travellers' Health Service website: http://www.news.gov.hk/en/category/healthandcommunity/050622/html/050622en05002.htm (Promed 6/23/05)

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2. Articles
CDC EID Journal, Volume 11, Number 7-July 2005
CDC Emerging Infectious Diseases Journal, Volume 11, Number 7-July 2005 issue is now available at: http://www.cdc.gov/ncidod/EID/index.htm. The following expedited articles are available online:
- Cost-Benefit of Stockpiling Drugs for Influenza Pandemic, R.D. Balicer et al.
- West Nile Virus Detection in Urine, J.H. Tonry et al.
- Real-time Polymerase Chain Reaction To Diagnose Lymphogranuloma Venereum, S.A. Morré et al.

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Foreign Affairs focuses on pandemic threat
The influential journal Foreign Affairs is adding its voice to the warnings about a potential influenza pandemic by publishing a special section on pandemics in its forthcoming July/August issue. Titled "The Next Pandemic," the section includes four articles by a panel of experts. They focus on the evidence that the H5N1 flu virus may spark a pandemic, the challenges of preparing for a pandemic, the need to integrate disease-control efforts for people and animals, and the lessons of the HIV/AIDS pandemic. The SARS (severe acute respiratory syndrome) epidemic gave a hint of the kind of economic disruption a pandemic could cause. Though only about 8,000 of SARS cases occurred, the disease cost the Asia-Pacific region an estimated $40 billion. Foreign Affairs is the second well-known journal in less than three weeks to publish a sizable collection of articles on the threat of a pandemic. The British journal Nature published 10 articles on the subject in its May 26 issue. Foreign Affairs has also scheduled a special press briefing on the pandemic issue for Jun 16 in Washington, DC. The briefing will feature two of the article authors, Laurie Garrett and Michael T. Osterholm, along with Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and James F. Hoge Jr., editor of the journal. The following articles are included in the Foreign Affairs July/August issue: 'The next pandemic?', 'Preparing for the Next Pandemic', 'One World, One Health', and 'The lessons of HIV/AIDS'. Foreign Affairs page with links to excerpts of three of the articles: http://www.foreignaffairs.org/background/pandemic/ (CIDRAP 6/10/05)

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Seroprevalence of poliovirus antibodies among children in a Dominican community--Puerto Rico, 2002
“…The U.S. territory of Puerto Rico (PR), located approximately 72 miles east of Dominican Republic (DR), has not had a case of paralytic polio since 1974. However, because of its proximity to DR and concerns that visitors and immigrants from DR (who tend to live in a separate community in PR) might not be fully vaccinated against polioviruses, the PR Department of Health (PRDH) and CDC assessed the seroprevalence of poliovirus antibodies among children aged 7--60 months in a predominantly DR community of PR. This report describes the results of that assessment, which indicated high levels of seropositivity for all three poliovirus serotypes. If vaccination rates remain high, the risk for a polio outbreak in this community is low. However, until all threats of poliovirus are eliminated globally, high rates of vaccination among preschool children must be ensured to prevent outbreaks of paralytic polio from any source (e.g., imported WPV, laboratory strains, or cVDPV) in the United States and its territories...” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5423a2.htm (MMWR June 17, 2005 / 54(23);580-581)

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HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex with Men--Five U.S. Cities, June 2004--April 2005
“Well into the third decade of the human immunodeficiency virus (HIV) epidemic, rates of HIV infection remain high, especially among minority populations. Of newly diagnosed HIV infections in the United States during 2003, CDC estimated that approximately 63% were among men who were infected through sexual contact with other men, 50% were among blacks, 32% were among whites, and 16% were among Hispanics. Studies of HIV infection among young men who have sex with men (MSM) in the mid to late 1990s revealed high rates of HIV prevalence, incidence, and unrecognized infection, particularly among young black MSM. To reassess those findings and previous HIV testing behaviors among MSM, CDC analyzed data from five of 17 cities participating in the National HIV Behavioral Surveillance (NHBS) system. This report summarizes preliminary findings from the HIV-testing component of NHBS, which indicated that, of MSM surveyed, 25% were infected with HIV, and 48% of those infected were unaware of their infection. To decrease HIV transmission, MSM should be encouraged to receive an HIV test at least annually, and prevention programs should improve means of reaching persons unaware of their HIV status, especially those in populations disproportionately at risk…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a2.htm (MMWR June 24, 2005 / 54(24);597-601)

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Use of Social Networks to Identify Persons with Undiagnosed HIV Infection--Seven U.S. Cities, October 2003--September 2004
“An estimated 250,000 persons living with human immunodeficiency virus (HIV) in the United States are not aware of their infections and their risk for transmitting HIV. As part of CDC's Advancing HIV Prevention Initiative, identifying persons with undiagnosed HIV infection and linking them to medical care and prevention services is a national priority. In 2003, a 2-year demonstration project was begun with nine community-based organizations (CBOs) in seven cities to evaluate the effectiveness of using a social network strategy at multiple sites to identify persons at risk for HIV infection and direct them to HIV counseling, testing, and referral (CTR). In this strategy, HIV-positive persons and HIV-negative persons at high risk (i.e., recruiters) are enlisted to recruit for CTR persons from their social, sexual, and drug-use networks (i.e., network associates [NAs]) believed to be at risk for HIV infection. This report summarizes preliminary results from the first year of this 2-year project, which indicated that 133 persons recruited 814 NAs, resulting in 46 newly identified HIV infections (approximately 6% of all persons tested). Health departments and CBOs should consider this strategy as an effective method for recruiting persons for CTR and identifying those with undiagnosed HIV infection…” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a3.htm (MMWR June 24, 2005 / 54(24);601-605)

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3. Notifications
CDC Update: Notice to Travelers, Avian Influenza A (H5N1)
CDC has updated their recommendations to travelers to reduce the risk of infection from avian influenza. Travelers visiting areas where outbreaks of H5N1 among poultry or human H5N1 cases have been reported should observe certain measures to help avoid illness. For more information visit: http://www.cdc.gov/travel/other/avian_flu_ah5n1_031605.htm (CDC 6/21/05)

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Fourth annual Syndromic Surveillance Conference
Join your colleagues at the fourth annual Syndromic Surveillance Conference September 13-15, 2005 in Seattle, Washington, USA. Public health practitioners, epidemiologists, statisticians and informaticists from around the world will convene to participate in plenary sessions, oral presentations, and a poster showcase focusing on descriptions of existing surveillance systems. The program committee includes members from the Philippines and Australia, and topics of discussion will include both domestic and international information system-based surveillance for Avian Influenza, SARS, bioterrorism, etc. The pre-conference workshop (13 Sep 2005) will offer hands-on, practical tools and provide take home examples of software and detection methods to use in daily practice. The workshop is only open to those employed by local, regional, or national public health agencies, or academic institutions.

Early conference registration discounts are available until July 1, 2005. The deadline for abstract submissions is July 15, 2005. Scholarships are available on a case-by-case basis. There is a block of rooms reserved at a special rate for extra meeting space. For more information visit: http://syndromic.org/con_2005_hotel.html. Please see the registration page of the web site (www.syndromic.org) or e-mail info@syndromic.org for more information.

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APEC Workshop on Development and Adoption of International Setting with a focus on Plant and Animal Health
October 18 - 22, 2005 (register by June 30, 2005)
USDA Center for Epidemiology and Animal Health (CEAH), Fort Collins, Colorado

The objective of the workshop is to provide animal and plant health specialists from APEC economies with an: 1) Opportunity to learn how international standards are developed and adopted in both the OIE and IPPC; 2) Overview of how individual economies would benefit from adhering to a uniform set of international animal and plant health standards; (3) Implementation of uniform standards for agricultural trade will help to facilitate the import and export of agricultural commodities throughout the APEC region; (4) An increased awareness and understanding within the APEC region of the OIE and IPPC and their respective standard setting processes will help ensure that member economies use a common set of criteria to promulgate animal and plant health regulations; (5) A common set of accepted international science-based standards would help to further promote agricultural trade within the region and; (6) Help to defuse current frustration with perceived regulatory delays in addressing market access requests for agricultural products. For more information visit the APEC website and click on the hyperlink "APEC Workshop on Development and Adoption...", under highlights. (APEC http://www.apec.org/apec.html)

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APEC Symposium on Response to Outbreaks of Avian Influenza and Preparedness for a Human Health Emergency
July 28-29, San Francisco, California, USA
The symposium will: Explore the important multi-sector (agriculture, human health, financial, and trade) aspects and impacts of AI in the APEC region; Identify capacity requirements and resource needs to address AI in APEC economies; Share information about the work of international standard-setting and international organizations’ information sharing and capacity building programs; Provide a forum for exploring domestic policies that might contribute to solutions in the agricultural, human health, financial, and trade sectors; and Encourage APEC economies to identify domestic factors that make it difficult to achieve goals for controlling animal and human disease.

For more information, contact: Tanya Fariña at APECAISymposium@usda.gov or visit the APEC website and click on the hyperlink "APEC Symposium on Response to Outbreaks of Avian Influenza...", under highlights. (APEC http://www.apec.org/apec.html)

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FDA approves a new vaccine to help protect adults against pertussis
The Food and Drug Administration (FDA) approved a new vaccine for a single booster immunization against pertussis (whooping cough), in combination with tetanus and diphtheria, for adolescents and adults 11-64 years of age. The vaccine will be marketed as Adacel by Aventis Pasteur Limited. Adacel is the first vaccine approved as a pertussis booster for adults. Adacel is a Tetanus Toxoid (T), Reduced Diphtheria Toxoid (d) and Acellular Pertussis Vaccine (ap), Adsorbed. Adacel contains the same components as Daptacel, a DTaP vaccine indicated for infants and children manufactured by Aventis Pasteur Limited, but the diphtheria toxoid and one of the pertussis components are in reduced quantities. Recently, FDA approved a similar vaccine called Boostrix, manufactured by GlaxoSmithKline, for use in adolescents 10-18 years of age. Pertussis is a highly communicable and potentially serious illness in adolescents and adults, and can cause prolonged cough and missed days at school and work. In young infants, pertussis is more frequently severe and can be fatal, particularly in those too young to be fully vaccinated. Since 1980, the rates of reported pertussis cases have been increasing in adolescents and adults, as well as in young infants. Adolescents and adults have been implicated as the source of pertussis infection for susceptible young infants, and other family members. (FDA 6/10/05 http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01361.html)

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National HIV Testing Day--June 27, 2005
National HIV Testing Day (NHTD) is June 27. NHTD is sponsored by the National Association of People with AIDS to encourage persons at risk to receive voluntary counseling and testing for HIV. This year's theme, "Take the Test. Take Control," highlights the need for testing and counseling persons at risk to maintain their health and protect their partners. In addition, this year marks the 20th anniversary of the first commercially available HIV test, and NHTD offers an opportunity to recognize how much progress has been made in diagnosing, counseling, treatment, and care since 1985. Approximately 1 million persons in the US are HIV positive, and nearly one quarter of those infected are not aware of their infections. HIV testing has become easier, more accessible, and less invasive than before. Persons who know they are infected can benefit from advances in medical care to prolong their lives and can take action to prevent transmission of HIV to others. For more information about where to get tested for HIV and events being held to encourage testing among populations at greatest risk: http://www.hivtest.org. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a1.htm (MMWR June 24, 2005 / 54(24);597)

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Management for International Public Health Course
(Sept. 12 - Oct. 21) Atlanta, Georgia, USA
Public heath management trainers from more than 58 countries have improved their management and training skills by attending the annual Management for International Public Health (MIPH) course that is offered every fall by the CDC in Atlanta. The course, developed in collaboration with Emory University, equips participants with the knowledge and skills to bring about constructive and meaningful change in their countries and organizations. The course is based on a set of core public health management competencies and covers the following themes and topics: Managing in an Organization, Managing Public Health Programs, Managing in a Changing Environment, Training of Trainers. For more information visit: http://www.cdc.gov/smdp/index.htm. (CDC http://www.cdc.gov/smdp/miphcourse.htm)

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4. APEC EINet activities
EINet article on Seattle Times' Editorials/Opinion section
APEC-EINet’s Drs. Ann Marie Kimball and Louis Fox recently wrote an article for the Seattle Times: “Infectious-disease network needs money to keep microbes at bay”. This special column is on the Editorials/Opinion section, and we invite you to read the article: http://seattletimes.nwsource.com/html/opinion/2002319477_kimball07.html. (note:, the statement, "Fifty-three human cases, with 21 deaths, have occurred to date" refers only to the third wave of clusters that occurred since mid December 2004.)

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5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list was established to enhance collaboration among health, commerce, and policy professionals concerned with emerging infections in APEC member economies. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe, go to: http://depts.washington.edu/einet/?a=subscribe or contact apecein@u.washington.edu. Further information about APEC EINet is available at http://depts.washington.edu/einet/.

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 apecein@u.washington.edu